The Medical Model

The medical model has long been the dominant model of our time for providing health services.  It has the most power, the most money, and the largest following.  Essentially it has these core components: a disorder, a scientific explanation for that disorder, a mechanism of change, healing actions, and specificity.  The disorder is whatever the problem or complaint is that puts the patient in need of services.  The scientific explanation is the etiology of that problem according to relevant research or theory.  The mechanism of change is whatever strategy will be used to solve the problem.  Healing actions are the specific interventions applied to the patient.  Specificity is the inference that the healing actions are what cures the patient.  These comprise the core of the medical model.

In the realm of medicine the strategy used is applying medical knowledge, and the healing actions are the actual treatments given, but in psychology the strategy is the theoretical approach of a given counselor, and the healing actions are the specific interventions used.  In medicine the interventions are physiochemical, but in psychology the interventions are psychological.  Both have incidental, or placebo, effects that are psychological.  This poses somewhat of a problem for psychology as both the specific interventions and the incidental effects are psychological.  Perhaps the medical model is not the best framework for psychology.

Nevertheless, psychology has adopted the medical model, which means it has had to fight for turf in the medical arena.  In the 1990s psychopharmacology started to assert that its treatments were more effective and more proven.  In response, psychology had to prove the effectiveness of its own treatments, which led to manualized treatments and contributed greatly to the thrust now known as evidence-based practice.

In the medical model everything must be proven, and since psychology has professionally fallen into this model, it leads to specific treatments having to be documented and then proven through research, as if they were a new drug being tested.

Counseling in the Chinese World Consultation: Diamond in the Rough

…or in the jungles of Thailand, as it were.

This consultation was not well known outside of certain circles, nor was it advertised beyond a few notifications.  It was arranged by humble people doing significant work, and attended by the same.  I did not have much idea of what to expect in coming here, but what I found was valued relationships, insightful discussions, rest for the weary, and vulnerable stories.

What made the conference so beautiful was the people who came.  We had counselors, professors, community leaders, counselor-trainers, students, spouses, nonprofit workers, and supervisors.  And they came from a variety of backgrounds, some from Chinese backgrounds, some from Western backgrounds, and some from a mix, and current living situations in all parts of China (Beijing, Chengdu, Sichuan, Kunming), Hong Kong, Taiwan, Thailand, Malaysia, and America.  Some came as teams, some as individuals, some as couples, and even some as families.  Many already knew some others, and many new connections were made.

Our backgrounds greatly enriched the conference but also posed some challenges.  The greatest challenge revolved around the truly bilingual composure of our group.  A little more than half of our 28 participants spoke Chinese as their heart language, and the remaining spoke English.  Of course, the vast majority of the group spoke both languages, enough to benefit from proceedings in either language, but a few speakers did not understand much at all of the other language.  So even though the least bilingual among us spoke at least some of the other language, it was not enough to understand a session.  This meant that a burden of translation fell onto the small portion of our members who spoke both languages well enough to translate.

Translation was a struggle throughout the conference, and taxed our most fluent members heavily.  We tried several different strategies, most often choosing to have simultaneous translation for small groups of people at a time so as not to slow down our meetings.  This language divide also permeated our informal interactions, with participants of the same heart language more likely to connect with each other than primary speakers of opposite languages.  However, I was impressed to see bilingual meal tables and a lot of code-switching (e.g. switching between English and Chinese), and plenty of persistent participants making connections with speakers of opposite languages as well.

Personally, I found the bilingual nature of this conference delightful yet stretching.  I was a little nervous when, as a primary English speaker, I was placed in a small group with three primary Chinese speakers.  I thought our small group would probably have to operate completely in Chinese, and worried that this might keep me from fully participating.  Our small group did operate mostly in Chinese, but I was absolutely delighted to discover that I could understand almost everything that my group members were saying.  Of course I didn’t understand every single word, but I understood their stories and what they were communicating.  And I even learned new words, and was reminded of old words I had forgotten, just from context.  This is extremely exciting to me because my cross-cultural growing up experience has made language a crucial issue for me.  One of my greatest longings is to have more language ability.  It is always disappointing when I realize how much more there is to learn, or compare my Chinese ability to my English ability and find them so disparate.  Conversely, it is always a great joy when I discover that I have succeeded in a new way or have made significant progress in learning Chinese.  The new success that I delighted in this time was that of understanding Chinese spoken on a vulnerable heart level.  Never before had I had Chinese friends communicate with me on the heart level in Chinese.  I felt I was opening new doors of potential for vulnerability in cross-cultural friendships.  I still cannot communicate in Chinese on that heart level, so thankfully my group was able to find a happy medium in that it was completely acceptable for me to talk in English, since they all understood it well enough to understand what I was saying.  So we had a small group in which each of us spoke in our heart language, and all of us understood.  This was truly precious to me.

It was stretching too in that I also got tired.  I can understand a lot, but it takes more work to understand Chinese than it does to just listen in English.  Listening in English is like breathing.  Listening in Chinese is like treading water.  My mother would add that listening to both simultaneously is like running uphill.  I sincerely admire international students who have learned English as a second language and now attend classes in that language.  If I was already feeling tired, I had to force myself to keep paying attention and understanding instead of just tuning out.  There are also other levels of understanding that I have not yet reached.  When in our meeting we watched four group members have an academic-level discussion on major issues that arise in doing counseling in the Chinese Christian world, there was too much that I could not understand, so I had to listen to someone else translate.  I dream of the day when I will be able to not only understand that level of discussion, but also communicate well enough to participate.

This conference also produced the treasure of rich discussions built on our diverse backgrounds, and facilitated by our flexible schedule.  When attending a conference, one usually expects to be given a schedule of specifically what will happen when, accompanied by appropriate descriptions.  The schedules that we were given upon arrival had very little detail, as well as very little correspondence to what actually happened during our conference.  I suppose fewer numbers of people all staying in the same place and eating the same meals does allow for easy rescheduling with just one announcement.  What really happened is that we would start one session and everyone got so involved that it went overtime.  Also, we took long breaks.  The breaks were supposed to be only 30 minutes long, but they turned out to be more like an hour long.  However, no one seemed to mind, because what was happening during the breaks was the same as what was happening in the sessions, people were sharing stories and learning from each other and encouraging each other.  In fact, this is what happened the whole week no matter what we were doing.  Whether we were in a session, in small groups, eating, walking, or just standing around talking, the stories and learning continued.

We had two “fishbowl” discussions that were particularly interesting.  Four or five people were chosen to discuss a certain topic while everyone else watched.  For the first we had a professor, a community leader, a counselor-trainer/director, and a former community leader who is now a counselor.  All were native Chinese with experience working in China.  They discussed tricky issues involved in doing counseling in the Chinese world.  It seems there are a complicated set of expectations that clients have for counselors and community leaders in China.  For example, community leaders are often expected to do counseling for free for members of their community.  At the same time, the members may not really be serious about doing the necessary work of counseling, and use the community leader’s lack of counseling qualifications as an excuse not to engage.  Some community leaders are really not qualified, and most are overburdened with other responsibilities.  Others actually are qualified, and for them it can be helpful to let clients know their qualifications.  Clients in China respect qualifications and will be more likely to engage if they know they are working with a professional.  On the other hand, there are not many counselors at all in China, so people in certain communities are being trained to do the work of counseling without going through a formal program, by other counselors.  It was also suggested that any clients be asked to pay at least a small sum of money so that they would take counseling more seriously and be willing to engage in the work.

The second fishbowl had a Chinese couple who had worked in the aftermath of the Sichuan earthquake for three years, and three other people to listen and reflect with them.  Their stories were incredible and heartbreaking.  Since they were living in the earthquake zone, they too experienced the aftershocks and trauma.  They would visit a small town and return later to find it completely wiped out by an aftershock.  People disappeared as quakes continued to shake.  All day long they listened to other people’s stories and grief.  They were so full themselves that this put a lot of tension on their marriage.  The husband wanted to be alone after hearing other people’s stories all day, but the wife wanted someone to talk to.  And in some cases, the grief they were dealing with was so intense, that the wife described feeling like an idiot and not knowing anything to do.  So she just sat for three days with children who had lost both their parents because their father killed their mother in his trauma, not saying anything.  She realized the children were talking to the dog, and that was the only time they would talk.  So she talked to the dog too.  She was able to bond with them by just being there for three days, feeling their pain and talking to the dog.  Slowly this couple is being restored and renewed.  They have left the earthquake zone and are learning to laugh again.  They have more time to be together as a couple, but this is a burden that leaves slowly.

We also had several case consultations, where a member would share about a client, and the rest of us would listen and give feedback.  One psychotherapist was working in a Malaysian city that did not have many other therapists.  She was the only one with her level of qualifications, working at a local hospital.  A man with schizophrenia came to see her, but became explosive and threatening when she confronted him about sending her long emails that he expected her to read in between sessions (and in smaller communities it is much more difficult to limit access to your email address).  She struggled with on one hand feeling compassionate toward him and wanting to help him but on the other hand feeling extremely threatened by him.  His psychiatrist had already told him that he could only be seen for prescribing medicine and not for psychotherapy. In situations like these it seems best for the counselor to become a mobilizer of resources.  She cannot continue to see him, but what she can do is recommend other resources to him.  Also, confidentiality became a different story after she found out he was her next door neighbor.  People in the complex need to know, since he is in danger of harming her.  Other stories were shared and this was a valuable venue for discussing some of the challenges of providing care within a smaller community where the counselor may also be part of the community.  It becomes essential for the community as a whole to take on some burdens of caring for hurting individuals in their midst.  Again, confidentiality becomes a different issue and the counselor needs to help clients become part of community.

None of these were planned or scheduled before the conference started, but anything that happened became a platform for rich interactions full of insight.

More vulnerable stories were shared during small group times and saturated our informal interactions.  These went hand in hand with rest for the weary, because part of the soul is restored when it has a chance to share its burdens with a kindred spirit.  I had my own story unpacked when I realized through conversation with my TCK roommate for the conference that I had “more issues than I thought” when it comes to crossing cultures.  There were painful aspects of my experience that I had ignored and thought I had skipped over.  But I realized I hadn’t skipped over them, I merely failed to recognize them.  It felt so relieving to be with someone who understood because she had experienced the same, and it was good to hear her insights.

The other aspect of rest was just getting away from our normal routines and schedules, escaping to the beautiful mountains of Thailand, just up the road from an elephant training camp.  I heard people exclaiming how they were so grateful to come to this conference because it was giving them rest for their minds, souls, and bodies.  The flexible schedule also made the conference more restful, because it gave a feel of doing whatever was needed, instead of pressure to get things done or obey a schedule.

This conference was incredibly valuable to me and others who attended.  It gave us the opportunity to connect with like-minded people and care for each other.  Some participants previously felt very isolated in their work and ministry, but now feel they have support accessible through a quick email or phone call.  It gave us a chance to listen to and learn from each others’ experiences.  It gave us a chance to rest.  It enriched our perspectives on counseling in the Chinese world.  This conference was truly a blessing.
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So were the elephants down the road...

PS. See more pictures here

https://picasaweb.google.com/sarspin/ThailandElephantsAndOrchids?authkey=Gv1sRgCPr0yt609v3bqwE&feat=directlink

References

Well, I finished that paper I was working on in several earlier posts.  Indeed, I was very thankful for having practiced writing about it on this blog.  It made it much easier to get started writing when I sat down to write the paper because I already had something to work with!  That paper was much easier to write than previous papers.  It was longer too!  I think it has a lot to do with how familiar I was with the content by the time I sat down to write.  I knew the facts, and could even remember which sources they came from.  A very nice feeling.

Since I never cited anything before when I wrote on here, I thought I should at least include a list of the references I used.  See below.
References

American Board of Professional Psychology. (n.d.) Retrieved from http://www.abpp.org/i4a/pages/index.cfm?pageid=3285

American Psychological Association (2010). Accredited internship and postdoctoral programs for training in psychology: 2010. American Psychologist, 65(9), 868–893. doi: 10.1037/a0021495

American Psychological Association (2009). Statement of the APA Board of Directors on the Internship Imbalance Problem. Retrieved from https://docs.google.com/viewer?url=http://www.appic.org/downloads/APA%2520Imbalance%2520Statement.pdf

Association of Psychology Postdoctoral and Internship Centers (n.d.) Retrieved from http://www.appic.org

Association of State and Provincial Psychology Boards. (2010). Psychology licensing exam scores by doctoral program. Retrieved from https://docs.google.com/viewer?url=http://www.asppb.net/files/public/ASPPBPsychExamScores3-19-10.pdf

Association of State and Provincial Psychology Boards. (n.d.). Retrieved from http://www.asppb.org

Chin, E. M. (2009). Using externships, internships, and postdoctoral placements to your advantage. In S. F. Davis, P. J. Giordano, & C. A. Licht (Eds.), Your career in psychology (pp. 135-150). Sussex, UK: Wiley-Blackwell.

DeAngelis, T. (2006). License to move. Monitor on Psychology, 37, 80. Retrieved from http://www.apa.org/monitor/julaug06/license.aspx

De Vaney Olvey, C., Hogg, A., & Counts, W. (2002). Licensure requirements: Have we raised the bar too far? Professional Psychology: Research and Practice, 33(3), 323-329. doi:10.1037/0735-7028.33.3.323

Hall, J. E., & Boucher, A. P. (2003). Professional mobility for psychologists: Multiple choices, multiple opportunities. Professional Psychology: Research and Practice, 34(5), 463-467. doi:10.1037/0735-7028.34.5.463

Logsdon-Conradsen, S., Battle, J., Anderson, P., Zimand, E., Sirl, K., Stapel, J., Ventura-Cook, E., Babat, N., & Kaslow, N. (2001). Formalized postdoctoral fellowships: A national survey for postdoctoral fellows. Professional Psychology: Research and Practice, 32(3), 312-318. doi:10.1037/0735-7028.32.3.312

Matthews, J. R., & Matthews, L. H. (2009). Preparing for licensure. In S. F. Davis, P. J. Giordano, & C. A. Licht (Eds.), Your career in psychology (pp. 151-162). Sussex, UK: Wiley-Blackwell.

National Register of Health Service Providers in Psychology. (n.d.) Retrieved from http://www.nationalregister.org/about.html

Robinson, J. D., & Habben, C. J. (2003). The role of the American Board of Professional Psychology in professional mobility. Professional Psychology: Research and Practice, 34(5), 474-475. doi:10.1037/0735-7028.34.5.474

Texas Administrative Code. (n.d.) Examining Boards, Texas State Board of Examiners of Psychologists, Applications and Examinations, title 22, part 21, chapter 463. Retrieved from http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=21&ch=463&rl=Y

Texas State Board of Examiners of Psychologists. (n.d.). Retrieved from http://www.tsbep.state.tx.us

Texas State Board of Examiners of Psychologists. (2007). Information for oral examination candidates. Retrieved from http://www.tsbep.state.tx.us/files/agencydocs/brochurenew.pdf

Certification Above and Beyond: Options for Overachievers

Some of you have received a license to practice as a psychologist in your state of choice, and you are not satisfied.  You want another credential to back up your training.  It turns out you have the grand opportunity of getting another credential, primarily through three organizations.  The first is the ASPPB (the progenitors of the EPPP).  The second is the National Register of Health Service Providers (NR).  The third is the American Board of Professional Psychology (ABPP).  Now I know the rest of you are thinking, "Oh, but I was completely satisfied when I got licensed.  What could induce me to go to the trouble of obtaining another credential when I just spent the past seven to ten years getting my doctoral degree and getting licensed?!"  That is a great question.

The ASPPB, NR, and ABPP each offer their own credential, with their own qualifying process, and of course, the accompanying fees.  Each of these beneficent organizations additionally offers you the opportunity to start banking your credentials with them before you graduate with your doctoral degree.  Maybe you haven't heard of credential banking: sending all of your credentials and qualifying documentation to one of these organizations, having them verify each credential and archive it in a file for you.  Later when you apply for licensure in one or multiple states, you can have that organization send all your qualifying credentials directly to the licensing board of your choice.  This would save you the hassle of collecting all the official documentation and having it sent to a licensing board yourself, each time you apply for licensure in a new state.  As for the credential that is offered by each organization, and obtained by meeting specific requirements, it is like that organization's seal of approval.  The hope is that some states will recognize the credential as satisfactory and grant you a license without needing to see all your original documentation, and many states do recognize some or all of these credentials.  In some cases a state licensing board may still require you to take a jurisprudence exam or waive only some of the requirements for licensure.

I am too bored at the moment to go into the specific requirements for each credential, but rest assured that whether you seek a credential or just a credential bank you will always have to pay an annual fee to maintain your credentials with one of these organizations.  Really, this is an enterprise that stems from the original monster of different requirements for licensure in each state and the increased mobility of today's world.  If all states had the same requirements for licensure, then all states could be part of one big agreement of reciprocity, and instead of resending credentials to each new state you would only have to show them a current license and take that state's jurisprudence exam.  How simple that would be!  Not to mention much cheaper!

Mobility remains the number one struggle in licensure.  Let's say you originally get licensed in a state with very few requirements for supervised hours.  After practicing for 15 years, you decide to move to Florida, which requires 4000 hours of supervised experience.  You didn't have an accredited internship and only had 1500 hours of postdoctoral supervision.  Even though you have been practicing for 15 years, you still won't be able to get licensed in Florida until you make up the rest of your supervised hours.  And who is going to supervise you?  Another psychologist, possibly one who has only been practicing for five years.  Does this make sense?

Sarah's reflective voice

In a conversation I had with a few family members today, I realized that perhaps the voice I use in my reflective posts comes across as melancholy or in need of encouragement.  Of course, I am always appreciative of encouragement, but I want to set readers at ease, that the voice you might have interpreted as depressed in the birthday posts is merely what my reflective voice sounds like.  I was not trying to send a message to my friends and family that they need to try harder at making me feel special on my birthday.  It was not meant to make anyone feel guilty.  I am sorry if that is what it became to some of my readers.  Really I was not upset at all, because a birthday is still what it always was.  I anticipate this birthday will be about the same as any birthday, just because it is a birthday.  The posts were merely an honest, interested examination of some of the thoughts that go through my head when I think about birthdays.

By my reflective voice I mean my thoughts.  I suppose that even my family members have not really heard my thoughts prior to my writing a blog.  To me it seems quite normal and calm.  If I were to define my reflective voice it would be defined as such: an honest exploration of my thoughts on a given topic.  When I write a reflective post on this blog, it is just putting my thoughts into writing.  Prior to writing the present blog, I never really shared much of my written thoughts with anyone.  Perhaps I did on Xanga a few times in high school, but other than that it only appeared in my mind and in the spiritual journals I keep.

There are, naturally, many times that I try to share my thoughts verbally.  These are however, a slim slice of all the things I think.  As anyone who knows me can attest, I am a thinker more than a speaker.  My friends often catch me looking up or off to the side in the midst of conversation, as I try to organize and compose my thoughts.  Sometimes I am successful and am able to say what it is that I think.  Other times I drift off into just thinking or a daze, I'm not quite sure what it should be called, and I cannot catch the thoughts.  If someone asks me what I was thinking I will say I don't know, and that is usually honest, because I cannot remember.  The thoughts just ran together, leading from one to the next.

My looking up or off to the side can be offsetting, just as perhaps my reflective prose can be.  Many times I have been asked if I am sad or concerned about something, when I was only thinking.  By now I have learned they are referring to the expression I had while thinking, so I quickly reply, "Oh no, sorry, that is just my thinking face!"  As we get to know each other better, friends learn to recognize and accept the thinking face, and associated pause.

Friends often tell me they wonder what I am thinking, so I have tried to get better at expressing at least some of what I was thinking when I made a thinking face or paused for a moment.  I do not want my friends to be afraid that I am harboring negative opinions of them, and think that is why I do not say what I was thinking.  That is very rarely the case, but I suspect that less well known friends often wonder if that is the reason for my pause.  I am merely digesting an organizing something that was said, trying to decide what I really think.

When I was 22...

I started my 23rd year with a long day of interviewing for grad school.  It turned out to be the longest, most tiring interview out of all of them.  It also turned out to be worth it, since it was an interview for the school I now attend as a first year Counseling Psychology doctoral student.  Because I planned to be at interviews all day, my expectations were very low.  I didn't expect anyone I was around to know it was my birthday, and none of the people who knew it was my birthday would have access to me.  So I was delighted when my parents called me internationally to wish me happy birthday, as I was being driven to campus.  And the day ended with ice cream and a good conversation with my host, who is now my roommate!

In my 23rd year God provided for me greatly.  He got me accepted at one school, so I would know where to go.  He affirmed me in his plan for me by giving me a housing offer from my roommate, the very same day I decided to go to the program.  He also gave me funding through an assistantship two days later.  He had me invited to go to a church at an interview, so that I would want to check out the sister church in the town I ended up in.  And that church has made all the difference here.  God graduated me from college.  He gave me rest during the summer.  He gave me a life in a new town.  He gave me a road bike AND a car.

There were many hard things.  I struggled to learn how to rest.  I had to cut back and give up activities I enjoyed.  I had to say goodbye to many, many friends, and a community in which I was known and respected.  I had to come to terms with unfulfilled desires.  I had to give up a boy, which proved difficult in a different way than with my only other boyfriend.  I struggled, and still struggle with making friends in a new place.  I experienced loneliness in a deeper way than ever before.  I worked hard at school.  Satan tried to wrest my hopes away from me, but God wouldn't let them be swept away completely.

I learned about the power of the Holy Spirit and about God's voice, in a way that increased my desire, humbled my self-image, and yet led to more frustration with a lesson on patience and perseverance.  I learned that God wants to be my best friend.

What has God been teaching you lately?

Birthdays

Hard to believe another year has passed.  I am about to be a new age.  I've always liked my birthday because I like feeling special, and my birthday is a day that's special just for me among my immediate family and friends.  I truly do not envy those who have their birthdays near Christmas, Mother's Day, [Taiwanese] Father's Day, or any other holiday.  Birthdays also bring me to a place of reflection, which I usually savor.  How is my life different now than it was in past years?  What does it feel like to be older?  What did I think this age would be like when I was younger?  What new things have I learned and accomplished?  And what do I think the next year will hold?  Who are my friends?

The reason I ask who my friends are, is because I want to do something special on my birthday.  I don't want to spend it alone.  Wanting things to be special can be problematic though, because there's this whole issue of expectations.  If I want it to be special, but it's not: disappointment.  And who wants to spend their birthday feeling disappointed?  So I find myself both asking and answering the question of who my friends are on my birthday.  First I ask the question for people in my same geographical location, so that I know who to celebrate with.  Then I answer the question by subconsciously keeping track of who remembers or wishes me a happy birthday.  And because I like being remembered and recognized on my birthday, but I know that a lot of my friends just don't have that great of memories for birthdays, I also drop a few hints in the weeks leading up to my birthday.  I've found that I'm a lot more likely to be remembered on my birthday just by giving people the chance to find out my birthday is soon!  I suppose that's a partial strategy for making my birthday more special and less disappointing.

It's pretty selfish!  Why does it matter so much to me to feel special and remembered?  On occasions I've considered what a birthday would be like prior to which I did not drop any hints and instead made it special by planning to bless others in my life on that day.  Maybe it would be better to give on my birthday instead of desiring to receive.  In fact that seems really similar to a Bible verse I've heard...along the lines of "it is more blessed to give than receive."  Why can't I actually believe that?

Do you like to feel special on your birthday?  What can make that day special for you?